Surgical port for stay sutures and system and methods thereof

ABSTRACT

A surgical port is disclosed. The surgical port has a cannular channel. The surgical port also has one or more suture slots in communication with the cannular channel. The surgical port further has a pair of cam grips for each of the one or more suture slots, each pair of cam grips comprising opposing gripping arms configured to allow suture to be pulled through the opposing gripping arms in a direction away from the cannular channel and to resist suture movement in a direction towards the cannular channel.

RELATED APPLICATION

This patent application claims priority to U.S. provisional patentapplication 62/507,737 filed May 17, 2017 and entitled, “SURGICAL PORTFOR STAY SUTURES”. The 62/507,737 application is hereby incorporated byreference in its entirety.

FIELD

The claimed invention relates to surgical devices, and more specificallyto surgical ports.

BACKGROUND

Laparoscopic, endoscopic, and other types of minimally invasive surgicalprocedures often rely on percutaneous introduction of surgicalinstruments into an internal region of a patient where the surgicalprocedure is to be performed. As part of many minimally invasivesurgical procedures, stay sutures may be placed in various tissue andthen tensioned either to pull the tissue out of the way or to move thetissue to a more convenient position for the surgeon to reach through aminimally invasive incision. Surgeons continue to find it desirable toutilize smaller and smaller access incisions in order to minimize traumaand reduce patient recovery times. Unfortunately, in some situations,the minimally invasive access incision is so narrow that it does notprovide a suitable angle for stay sutures to pull tissue away from theaccess channel afforded by the minimally invasive incision. Therefore,it would be desirable to have an improved device for routing the staysutures separately from a main surgical access point while enablingconvenient adjustment of the stay suture tensions.

SUMMARY

A surgical port is disclosed. The surgical port has a cannular channel.The surgical port also has one or more suture slots in communicationwith the cannular channel. The surgical port further has a pair of camgrips for each of the one or more suture slots, each pair of cam gripscomprising opposing gripping arms configured to allow suture to bepulled through the opposing gripping arms in a direction away from thecannular channel and to resist suture movement in a direction towardsthe cannular channel.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates one embodiment of a surgical port having oneembodiment of a needle installed therein.

FIGS. 2A, 2B, 2C, 2D, 2E, and 2F are front, left side, right side, rear,top, and bottom elevational views, respectively, of an upper flangecover for the surgical port of FIG. 1.

FIGS. 3A, 3B, 3C, 3D, 3E, and 3F are front, left side, right side, rear,top, and bottom elevational views, respectively, of a lower flange ofthe surgical port of FIG. 1.

FIGS. 4A-4D are exploded views illustrating the assembly of oneembodiment of a surgical port.

FIG. 5 is a partially exposed view of a surgical port through which theends of a stay suture have been drawn.

FIGS. 6A-6C illustrate operation of one embodiment of cam grips.

FIG. 7 illustrates one embodiment of a surgical port system.

FIGS. 8A-8E illustrate one embodiment of a method for installing thesurgical port of FIG. 7 in a patient.

FIGS. 9A-9F illustrate one embodiment of a method for pulling a staysuture through the surgical port of FIG. 7 using the hook of FIG. 7.

FIGS. 10A-10J illustrate one embodiment of a method for pulling a staysuture through the surgical port of FIG. 7 using the snare of FIG. 7

It will be appreciated that for purposes of clarity and where deemedappropriate, reference numerals have been repeated in the figures toindicate corresponding features, and that the various elements in thedrawings have not necessarily been drawn to scale in order to bettershow the features.

DETAILED DESCRIPTION

FIG. 1 illustrates one embodiment of a surgical port 20 having oneembodiment of a needle 22 installed therein. The tip of the needle 22can be seen extending from a cannular channel 24 of the surgical port20. The needle 22 has a handle 26 which is sized to prevent the handle26 from passing through the cannular channel 24. The cannular channel 24is coupled to a flange 28.

In practice, the needle 22 is installed in the surgical port 20 when itis desired to place the surgical port 20 into a patient. Alternatively,the needle 22 may come pre-installed in the surgical port 20 as shown inFIG. 1. The cannular channel 24 may be flexible, and if so, the insertedneedle 22 provides some stiffness to the cannular channel 24. Asconfigured in FIG. 1, the needle may be used to pierce through the skin,which tends to be tougher to pass through than the tissues beneath theskin. When the skin is just pierced and the distal end 30 of thecannular channel 24 has passed through the skin, the needle 22 may beremoved from the surgical port 20 by pulling on the needle handle 26 andholding the flange 28 steady. If the cannular channel 24 is stiffenough, the flange 28 may be used to push the distal end 30 of thecannular channel 24 through internal tissue, for example, muscle tissueuntil the flange 28 rests on the outer surface of the patient.Alternately, and especially if the cannular channel 24 is not rigid, ablunt obturator (not shown in FIG. 1) may be inserted into the cannularchannel 24 in place of the needle 22. The distal tip of such a bluntobturator could extend past the distal end of the cannular channel 24and could be used to insert the cannular channel 24 of the surgical portthrough the tissue below the skin. The blunt obturator would tend toavoid harming the tissue through which it passed.

Once the cannular channel 24 reaches a desired position, the obturator(if used) could be removed. The access opening created by the cannularchannel 24 can be on the order of 1-2 mm or smaller, creating verylittle trauma to the patient.

With the surgical port 20 in place, a snare or hook sized to fit withinthe cannular channel 24 may be inserted into the patient through thecannular channel 24 in order to capture stay suture ends which have beenstitched through tissue. The stay suture stitches would typically havebeen placed via access from the main minimally invasive incision. It isdesirable, however, to be able to pull the stay sutures at an angledifferent from that provided by the minimally invasive incision.Therefore, if the stay suture ends are captured by a hook or snareplaced through the cannular channel 24 of the surgical port 20, the staysuture ends may be pulled through the cannular channel 24 and out of thesurgical port 20.

In this embodiment, the flange 28 is made from an upper flange cover 32and a lower flange 34 (which is not visible in the view of FIG. 1). Theflange 28 defines multiple suture slots 36A, 36B.

FIGS. 2A, 2B, 2C, 2D, 2E, and 2F are front, left side, right side, rear,top, and bottom elevational views, respectively, of the upper flangecover 32. The upper flange cover 32 defines tab receiving openings 38Aand 38B which are visible in the front and rear views, respectively, ofFIGS. 2A and 2D. The tab receiving openings 38A, 38B are configured toattach to corresponding tabs on the lower flange 34 (not visible inFIGS. 2A-2F). In this embodiment, the upper flange cover 32 also definesthree cam pockets 40A, 40B, 40C, the features of which will be discussedin more detail later in this specification. The upper flange cover 32also defines an opening 42 which works in conjunction with a similaropening in the lower flange to couple and communicate with the cannularchannel.

FIGS. 3A, 3B, 3C, 3D, 3E, and 3F are front, left side, right side, rear,top, and bottom elevational views, respectively, of the lower flange 34.The lower flange has tabs 44A, 44B which are configured to correspondand couple to tab receiving openings 38A, 38B for coupling the lowerflange 34 to the upper flange cover. The lower flange 34 also has aplurality of cam stops 46, the features of which will be discussed inmore detail later in the specification. The lower flange 34 also definesan opening 48 which is configured to receive a portion of the cannularchannel.

FIGS. 4A-4D are exploded views illustrating the assembly of oneembodiment of a surgical port. As shown in FIG. 4A, one or more camgrips 50A, 50B, 52A, 52B are set into the cam pockets 40A, 40B, 40C ofthe upper flange cover 32. Specifically in this embodiment, cam grip 50Ais set into cam pocket 40C; cam grip 50B and then cam grip 52B are setinto cam pocket 40B; and cam grip 52A is set into cam pocket 40A. Eachcam grip has a gripping arm 54. The gripping arms 54 of cam grips 50Aand 50B face each other, while the gripping arms 54 of cam grips 52A and52B face each other. The pair of gripping arms 54 on cam grips 50A and50B are aligned to lie in substantially the same plane. Similarly, thepair of gripping arms 54 on cam grips 52A and 52B are aligned to lie insubstantially the same plane. In this particular embodiment, all of thegripping arms 54 will lie in substantially the same plane. Since camgrips 50B and 52B are both installed in the same cam pocket 40B, all ofthe gripping arms 54 are made to lie in the same plane by making campockets 40A, 40B deeper than cam pocket 40C, and also by extending thegripping arms 54 of cam grips 52A and 50B higher than the gripping arms54 of cam grips 50A and 52B. In other embodiments, the pairs of grippingarms may lie in different planes.

As shown in FIG. 4B, the distal end 30 of the cannular channel 24 isinserted into the upper side of the opening 48 in the lower flange 34.In this embodiment, the cannular channel 24 has a stepped proximal end56 which corresponds to the shape of opening 48 and is configured toprevent the proximal end 56 from passing all the way through opening 48in the lower flange 34. These components may be held together untilfurther assembly, or they may be coupled together using a variety oftechniques, including, but not limited to gluing, ultrasonic welding,press fitting, and heat bonding.

As shown in FIG. 4C, the resultant assembly of FIG. 4B has been turnedupside-down and is being aligned with and installed into the resultantassembly of FIG. 4A. The tabs 44A, 44B will be snapped into the tabreceiving openings 38A, 38B. The opening 42 in the upper flange cover 32is sized to communicate with the cannular channel opening in theproximal end of the cannular channel (not visible in this view). Whenattached to the upper flange cover 32, the lower flange 34 also isconfigured to keep the cam grips 52A, 52B, 50B (not easily visible inthis view because it is partially beneath cam grip 52B), and 50A fromfalling out of cam pockets 40A, 40B, 40C.

As shown in FIG. 4D, the needle 22 may be inserted into the cannularchannel 24 of the fully assembled surgical port 20 through the openingin the flange 28. Alternatively, an obturator 58 may be inserted intothe cannular channel 24. As discussed above, the obturator would have ablunt tip 60 which would be sized to extend past the distal end 30 ofthe cannular channel 24. The obturator 58 may also have a handle 62 forease of use and to prevent the obturator 58 from passing all the waythrough the cannular channel 24 and into a patient.

FIG. 5 is a partially exposed view of a surgical port 20 through whichthe ends 64A, 64B of a stay suture 66 have been drawn. This may be doneby using a hook or a snare as described above. The stay suture 66 isshown looping out of the distal end 30 of the cannular channel 24 forsimplicity, however, it should be understood that such a stay suture 66would be stitched through a desired tissue when in actual use. The staysuture ends 64A, 64B are pulled up through the cannular channel 24 andthen down into the suture slots 36A, 36B, respectively. Suture slot 36Bis not visible in this partially exposed view, allowing us to see moreclearly how the suture may be engaged with the cam grips 52A, 52B. Inparticular, it can be seen that the suture leading to suture end 64B hasbeen drawn through the opposing gripping arms 54 of cam grips 52A, 52B.As schematically illustrated in FIGS. 6A-6C, the cam grips 52A, 52B,50A, 50B are able to rotate slightly within a small range defined by thecam pocket and the cam stops (not shown in this view). The broken linepositions in FIG. 6C illustrates one end of the range of motion, whilethe solid line positions in FIG. 6C illustrates the other end of therange of motion for the cam grips 52A, 52B, 50A, 50B. This motion allowssuture 64A, 64B to be drawn in-between respective pairs of gripping arms54. The gripping arms 54 are configured to resist motion of the suture64A, 64B in a backwards direction 68 while allowing the suture to bepulled to a desired tension in a forwards direction 70. The opposingpairs of gripping arms 54 may be configured to hold a single suture ormultiple suture strands. In this way, stay sutures snared or hooked backthrough the surgical port 20 may be held in place by pulling the sutureends down into one or more suture slots 36A, 36B. The gripping arms 54will hold the suture at the set tension.

FIG. 7 illustrates one embodiment of a surgical port system 72. Thesystem 72 has a surgical port 20, an obturator 74, a hook 76 device, anda snare device 78. The surgical port 20 has a flexible cannular channel24 in this embodiment. The obturator 74 may be placed into the opening42 of the surgical port 20 to enable the enable the flexible cannularchannel 24 to be passed through tissue exposed by a small skin incision.The obturator 74 may then be removed from the surgical port 20 andeither the hook device 76 or the snare device 78 may be placed into theopening 42 for capturing the ends of a stay suture and pulling them outof the surgical port 20. The hook device 76 has a distal hook 80 with anatraumatic tip for grabbing the desired suture. The snare device 78 hasa plastic target 82 at its distal end. The plastic target 82 is held bya snare loop 84 (not easily visible in FIG. 7, but visible in FIG. 10A).The snare loop 84 extends through a metal tube 86 where it is coupled toa curved metal handle 88. The plastic target 82 can be removed from thesnare device 78 to expose the snare loop 84. The snare loop 84 and theend of the metal tube 86 near the snare loop 84 may be placed into theopening 42 and through the flexible cannular channel 24 of the surgicalport 20. A desired suture can be placed through the snare loop 84, andthe curved metal handle 88 and metal tube 86 can be simultaneouslypulled away from the surgical port 20 to draw the suture in the snareloop 84 out of the opening 42. The stay suture ends may be tensioned asdesired and then pulled into suture slots 36A, 36B of the surgical port20. Each suture slot 36A, 36B can hold a pair of suture ends asdescribed above, so each surgical port 20 may be used with at least twostay sutures.

FIGS. 8A-8E illustrate one embodiment of a method for installing thesurgical port of FIG. 7 in a patient. As illustrated in FIG. 8A, a smallskin incision 90 is opened at a desired location on a patient for staysuture passage based on a surgeon's preference and experience. Theobturator 74 is aligned with the opening 42 on the surgical port 20 andthen placed 92 into the opening 42 until the handle 94 of the obturator74 contacts the surgical port 20 as shown in FIG. 8B. As shown in FIG.8C, the obturator 74 and cannular channel 24 of the surgical port 20 areinserted through the incision 90. The obturator 74 can be workedcarefully through the underlying tissue, taking care to avoid locationof known blood vessels, nerves, and other sensitive structures andorgans, until the surgical port 20 contacts the patient as shown in FIG.8D. As shown in FIG. 8E, the obturator 74 may be removed 96 while thesurgical port 20 is held against the patient.

FIGS. 9A-9F illustrate one embodiment of a method for pulling a staysuture through the installed surgical port 20 using the hook device 76.The distal end of the hook device 76 may be inserted into the opening 42of the surgical port 20 as shown in FIG. 9A. As illustrated in thesimulated endoscopic visualization view of FIG. 9B, one or both strandsof the desired stay suture 98 may be captured within the distal hook 80of hook device 76 by manipulating the proximal handle 100 of the hookdevice 76 outside of the patient as shown in FIG. 9C. As shown in FIG.9D, the hook device 76 may then be pulled 102 out of the patient whilesteadying the surgical port 20 to bring the stay suture 98 ends 98A, 98Bout of the surgical port 20. As shown in FIG. 9E, the stay suture ends98A, 98B can be tensioned 104 per surgeon's discretion to position thetissue held by the stay suture 98 as desired. As shown in FIG. 9F, thestay suture ends 98A, 98B can be locked to maintain the desired tensionby pulling 106 them down into one of the suture slots 36B.

FIGS. 10A-10J illustrate one embodiment of a method for pulling a staysuture through the surgical port of FIG. 7 using the snare device 78. Asshown in FIG. 10A, the plastic target 82 may be pushed 108 out of thesnare loop 84. As shown in FIG. 10B, the snare loop 84 may be foldedback against the tube 86 of the snare device. As illustrated in FIG.10C, the folded loop 84 end of the snare device may be inserted 110 intothe opening 42 of the surgical port 20. The tube 86 should be insertedfar enough through the cannular channel for the snare loop 84 to exitthe cannular channel 24 inside the patient as shown in the simulatedendoscopic visualization view of FIG. 10D. As illustrated in thesimulated endoscopic visualization view of FIG. 10E, the snare loop 84may be placed over the sewing end of a suturing device 114 inside thepatient. The suturing device 114 may be an automated suturing device ora needle grasping device. As illustrated in FIG. 10F, a stay suture 116may be sewn into a desired suture location using the suturing device114. As schematically shown in FIG. 10G, the suturing device 114 may bewithdrawn 118 back through the snare loop 84 (thereby pulling the staysuture through the snare loop 84) and, outside of the patient, the staysuture ends 116A, 116B may be cut to separate them from the suturingdevice 114 or any needle caps or needles to which they might beattached. As shown in FIG. 10H, the snare device 78 may be pulled 120out of the patient while steadying the surgical port 20 to bring thestay suture ends 116A, 116B out of the surgical port 20. As shown inFIG. 10I, the stay suture ends 116A, 116B can be tensioned 122 persurgeon's discretion to position the tissue held by the stay suture 116as desired. As shown in FIG. 10J, the stay suture ends 116A, 116B can belocked to maintain the desired tension by pulling 124 them down into oneof the suture slots 36B.

Various advantages of a surgical port for stay sutures have beendiscussed above. Embodiments discussed herein have been described by wayof example in this specification. It will be apparent to those skilledin the art that the foregoing detailed disclosure is intended to bepresented by way of example only, and is not limiting. Variousalterations, improvements, and modifications will occur and are intendedto those skilled in the art, though not expressly stated herein. Thesealterations, improvements, and modifications are intended to besuggested hereby, and are within the spirit and the scope of the claimedinvention. The drawings included herein are not necessarily drawn toscale. Additionally, the recited order of processing elements orsequences, or the use of numbers, letters, or other designationstherefore, is not intended to limit the claims to any order, except asmay be specified in the claims. Accordingly, the invention is limitedonly by the following claims and equivalents thereto.

What is claimed is:
 1. A surgical port, comprising: an enclosedcylindrical cannular channel; one or more suture slots in communicationwith the enclosed cylindrical cannular channel; and a pair of cam gripsfor each of the one or more suture slots, each pair of cam gripscomprising opposing gripping arms configured to allow suture to bepulled through the opposing gripping arms in a direction away from theenclosed cylindrical cannular channel and to resist suture movement in adirection towards the enclosed cylindrical cannular channel, wherein inone cam grip of at least one of the pair of cam grips, the gripping armportion extends higher than the remainder of the cam grip.
 2. Thesurgical port of claim 1, further comprising one or more cam pocketsconfigured to receive the cam grips.
 3. The surgical port of claim 2,wherein there are three cam pockets.
 4. The surgical port of claim 3,wherein: a first cam pocket receives one cam grip; a second cam pocketreceives one cam grip; and a third cam pocket receives two cam grips. 5.The surgical port of claim 3, wherein one cam pocket is deeper than theother two cam pockets.
 6. The surgical port of claim 2, wherein thereare two cam pockets, and wherein one of the cam pockets is deeper thanthe other cam pocket.
 7. The surgical port of claim 1, furthercomprising a flange coupled to the enclosed cylindrical cannularchannel.
 8. The surgical port of claim 1, wherein there are two pairs ofcam grips.